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Published On December 12, 2017

CLINICAL RESEARCH

Retired, Took Up Drinking

Alcohol use is at an all-time high among older Americans, and that trend brings a host of health risks.

The holidays mean that many people will be raising a glass. The spirits industry makes more than a quarter of its annual profits between Thanksgiving and New Year’s, and violations for drunk driving go up by a third during the same period. But one population may be less likely to leave the bottle on the shelf when January comes: older Americans.

A recent study from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that people 65 years and older increased their alcohol use by more than 22% between 20012002 and 20122013. This group also showed a nearly two-thirds increase in high-risk drinking, defined as binge drinking at least once a week for a year or more. Alcohol-use disorder, the most severe level of dependency, more than doubled among seniors.

The implications for their health are unambiguous. Older people are more likely to have conditions that can be complicated by alcohol and medications that interact with it. Older bodies also become intoxicated more quickly, leading to a greater risk of falls or other injuries. Faced with this dangerous demographic shift, researchers are looking both at its root causes and at what interventions are most likely to help.

Part of the trend may be generational, says Aaron White, senior scientific advisor to the director of the NIAAA. “You have this whole cohort of Boomers with a history of higher levels of alcohol and drug use, and perhaps they are bringing this with them into retirement,” he says.

A more troubling interpretation is that increased alcohol use by this group may be related to a spike in so-called deaths of despair—a phenomenon described by Anne Case and Angus Deaton in their papers for Proceedings of the National Academy of Sciences and the Brookings Institute. While many Americans aged 4554 showed marked improvement in their health outcomes between the 1970s and the recession of 20082009, that didn’t happen for Caucasian Americans with an education level of a high school degree or less. This group saw notable increases in alcohol use, drug overdoses and suicide.

“After the productivity slowdown in the early 1970s, and with widening income inequality,” write Case and Deacon in their 2015 study, “many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents.”

White wonders whether some seniors might increase their alcohol use in retirement to cope with economic hardship. “Senior years may be a time of facing their disappointment in life,” he says.

Whatever the reasons, increased use of alcohol carries greater physical dangers in seniors. “Blood-alcohol levels go up higher per drink in older people,” notes Marc Schuckit, professor of psychiatry at University of California, San Diego, who penned JAMA Psychiatry’s editorial response to the NIAAA study. A senior gets more drunk than someone much younger of the same size, because older people’s bodies lack muscle mass and the extra water in their systems that help younger people buffer the effects of alcohol.

The sedative powers of alcohol, affecting balance and coordination, also appear to increase with old age. Performance in driving simulators has demonstrated greater impairment after a few drinks for older people compared with those who are younger. And research by NIAAA suggests that approximately four out of five people 65 and older who consume alcohol in a given year also take a medication that could be affected by drinking—sometimes to dangerous effect.

“Alcohol can suppress those areas deep in the brainstem that control breathing, heart rate and the gag reflex,” says White. Because opioids do the same, “alcohol reduces the amount of opioid medication needed to cause death.”

Health conditions that more frequently affect older people are worsened by alcohol, notes White. These include poor sleep, the risk of falls and full-body inflammation, all of which alcohol and chronic binge drinking may exacerbate.

While it’s difficult to get anyone to commit themselves to treatment, seniors face different challenges than younger people, notes Schuckit. Older people who live on their own, without much social support, are less likely to have contact with someone who will say, “‘You know, you have a problem, and you need help,’” says Schuckit.

They do have contact with their doctors, however—nearly 9 out of 10 people ages 65 and older have seen a physician in the last six months. Yet even that likely avenue to treatment may be cut off by a lack of physician training concerning alcohol use; Schuckit describes the likelihood of such training as “disappointingly small.” Simple tools can help, he says, including a 10-question Alcohol Use Disorders Identification Test that patients can complete in the waiting room.

Doctors also need to realize they are likely to be the principal source of information about the dangers of a patient’s alcohol use, says White. “A lot of people are just not aware that drinking for relaxation and to cope could be damaging to them,” he says, adding that in light of the new data showing the extent of risks to older patients, “physicians should be asking about drinking and making recommendations.”